Ian Gregg

Ian Gregg advanced our understanding of asthma and kindred disorders by improving methods of measurement, monitoring and management and by clarifying causative factors. When he decided to enter general practice four years after he qualified, he had by then acquired considerable experience and expertise in respiratory medicine, and was imbued with an enthusiasm for the subject which proved lifelong. At a time when continuing research in general practice was not encouraged and indeed usually frowned upon, he was determined to keep personal links with hospital-based respiratory medicine and, at the same time, to search out answers to common problems, which he knew could only be effectively approached from the perspective of general practice. Far from falling off Lord Moran’s proverbial ladder, still then a pervasive concept, Ian bravely set about constructing his own unique career.

Ian Gregg was born and educated in London. His father, Basil Edward Pease Gregg, was a Quaker by persuasion and an underwriter by profession. His mother was Winifred Standish née Thomson. His maternal great-great-grandfather was Anthony Todd Thomson [Munk’s Roll, Vol.IV, p.29], the first professor of materia medica and therapeutics at the University of London. On leaving Westminster School in 1943, Ian served in the Army for four years in India and then saw action in Sumatra. On arrival in India, after recovering from amoebic dysentery, he was commissioned in the Royal Garwhal Rifles. He became fluent in Hindi, Urdu and Garwhali, linguistic skills he retained in later life, sometimes causing astonishment when encountered unawares by speakers of these languages in England.

Following demobilisation, he went up to Wadham College, Oxford, then for his clinical years to the Westminster Hospital Medical School. House jobs followed at the Westminster Hospital, the Brompton Hospital and at St Stephen’s Hospital, Chelsea, after which he was a medical registrar at St Stephen’s. In 1953, Ian Gregg and Mary Chanter, a Westminster-trained staff nurse, were married.

From 1958 to 1973, Ian became a principal in general practice in Roehampton with the demanding and full range of commitments and responsibilities which were then taken for granted. He also attended regularly at the Westminster Hospital chest clinic as a clinical assistant. From 1973 to 1982 he was director of the department of clinical epidemiology in general practice at the cardiothoracic institute of the Brompton Hospital, where he was appointed an honorary consultant physician. To find more flexibility, he resigned from the practice he had built up in Roehampton and joined a practice in Kingston-on-Thames which was a little less onerous. From 1982 to 1987, he was a senior research fellow and senior lecturer in the department of primary care at the University of Southampton and at the same time had responsibilities in general practice in Southampton.

Anyone who has been asked formally to “blow through this tube” will almost certainly have used an instrument invented by the ingenious pathologist turned bioengineer, Martin Wright [Munk’s Roll, Vol.IX, p.641]. One of the most widely used of all Wright’s many practical inventions is the peak flow meter, first described in 1956, to measure an individual’s maximum ability to expel air from the lungs or peak expiratory flow rate (PEFR). A robust, hand-held miniature version was developed some time later. Ian immediately realised the potential of this device, the use of which he explored for many years in general practice with a zeal at times approaching missionary fervour. During early work of calibration and establishing variations and ranges of normal, unsuspecting visitors to the Gregg household were also politely pressed into pulmonary service. Fruitful collaboration with Andrew Nunn, a statistician, led to the publication of a key paper: ‘Peak expiratory flow in normal subjects’ (Brit.med.J., 1973, 3, 282-284). Early on Ian Gregg taught and encouraged patients in his practice with respiratory problems to record their own peak flow readings, if necessary several times a day. Prior to this, investigations even as simple as peak flow recordings were only available in general practice. Even the simplest tests of lung function were customarily then only available to GPs by referring a patient to a consultant with access to a lung function laboratory. Gregg knew only too well how wasteful, inadequate and anachronistic such requirements were. His impressive achievement was to transform attitudes and practice in this field, throughout the profession; his name came to be associated with peak flow meters used in everyday circumstances and available as a matter of course in the doctor’s surgery. More fundamentally, in studies carried out with collaborators, he threw light on the aetiology, the extent of reversibility and the natural course of asthma, particularly recognising the role of viral and secondary infection in asthma, in wheezy bronchitis in children and in adult chronic bronchitis.

Ian built up his own collection of primary published sources written by observers, thinkers, interpreters and commentators on respiratory disorders, as well as those who questioned the prevailing dogmas of their time. This was not a fusty resource for antiquarian homage, but formed the foundation for the historical perspective he brought to the subject, exemplified for instance in the reviews he wrote on the epidemiological aspects of asthma and his account of ‘Some historical aspects of asthma’ (Southampton Medical Journal 7 1 [1991] 11-22). After retirement to a new family home at Eynsham, Oxford, he extended personal links he had with the centre for medical history at the University of Exeter where, with his wealth of experience, enquiring mind, genius for friendship and stimulating company, his contributions to clinical teaching and to the life of the department were greatly appreciated.

He made forays into many aspects of medical history and contributed to the section concerning the College archives in The Royal College of Physicians and its collections: an illustrated history (London, Royal College of Physicians, 2001). He shed new light on the life and times of his medical ancestor, Anthony Todd Thomson. Painstaking analyses of the London Bills of Mortality from the mid-17th century to the early 18th century was one of several projects he undertook, for which he relied particularly on the resources of the College library. A few remarks upon the natives of Van Dieman’s Land is the title of a College manuscript which lay unnoticed until Ian, relying on a combination of sleuthing and serendipity, traced the identity of the young author, John Barnes, who in 1829 discussed medical and anthropological aspects of the last surviving aborigines in Tasmania.

Once the implications of Ian Gregg’s research were widely appreciated, he found himself in constant demand at home and abroad as a lecturer, teacher or in the role of visiting professor. His expertise, love of travel, linguistic abilities, curiosity, and empathy contributed to the success of his innumerable sorties, near and far. He was fond of recounting that, on one occasion, during discussions which followed a ward round at a world famous trans-Atlantic teaching hospital, he was invited to contribute. He explained that as a medical student he had been taught that, however distinguished the doctors were in a hospital, patients were always more important; he went on to ask whose job it was here to inquire how the patient felt. Ian Gregg’s life was moulded by his deeply held altruistic and humanitarian convictions, manifest in many causes he espoused, such as the Campaign for Nuclear Disarmament and Amnesty International. As a supporter of the Eritrean liberation struggle, he was invited on an arduous and dangerous trip in 1989 to help set up primary health care in liberated areas of Eritrea. In his professional life he led and inspired junior colleagues by example and, at the same time, was among only a few in each generation who have altered accepted patterns of practice in medicine.